Research summary

Most people desire to have children at some point in their lives. My research explores how people make plans about parenthood and act to achieve them. The goal is to understand how psychologists and other healthcare providers can support people in achieving their goals or, when this proves impossible, in coming to terms with unrealized parenthood goals.

Currently, I am interested in developing innovative psychosocial interventions that can be delivered by different healthcare providers without specific mental health training and that are easily accessible to patients. The goal is to explore new ways of organizing psychosocial care that break with the traditional one-to-one counselling format (i.e., individual sessions with patients), in order to make psychosocial care more accessible for all patients during routine care, as well as to particular groups of individuals that are outside the healthcare system, for instance people who did not achieve parenthood with fertility treatment and have to cope with undesired childlessness.

Specific topics of research are:

parenthood decision-making

psychosocial adjustment during and after fertility treatment, whether it is successful (transition to parenthood) or unsuccessful (undesired childlessness)

evidence-based psychosocial support in fertility care

development and implementation of evidence-based psychosocial guidelines

patient centred care

psychosocial screening in healthcare settings

compliance with fertility treatment

My research is theory driven, therefore I am also interested in all types of research that try to validate and develop theory within the following areas:

attachment and parenting

interpersonal relationships

developmental models of crisis and change across the life-span

decision-making

motivational self-regulation

behavioural change

Finally, being a Mathematician, I am also interested in advanced statistics and methodology for social and developmental research, such as multilevel modelling, growth curve models, structural equation modelling, meta-analysis, etc.

Book sections

Research topics and related papers

Psychosocial care during fertility treatment Many infertile individuals undergo fertility treatment such as In In-Vitro Fertilization (IVF) to conceive. Each IVF cycle includes approximately two weeks of self-injection with fertility drugs to stimulate multiple oocyte maturation, their retrieval via transvaginal ultrasonography and fertilisation with partner or donor sperm, transfer of the resulting embryo(s) to the uterus and a 2-week waiting period to ascertain if pregnancy was achieved. Fifteen and 11% of women undergoing IVF meet criteria for anxiety and depression disorders, respectively. I conduct cross-sectional and prospective observational studies to

understand how patients adjust during fertility treatment

identify risk factors for poor adjustment

assess patients needs and preferences regarding the care they receive at fertility the clinics and how these are associated with their wellbeing

Compliance with fertility treatment Fertility treatment offers infertile individuals and other people that cannot conceive spontaneously (e.g., gay couples, single women) the possibility of having children of their own. However, treatment is demanding and changes per cycle are low, so patients should undergo repeated treatments cycles to optimize their chances of parenthood. Not all patients seem to be able to undergo the treatment cycles recommended, despite having a good prognosis and financial resources to cover treatment. I conduct research to understand the factors that make it difficult for patients to comply with treatment recommendations and how we can improve care so that fertility treatment it is more patient friendly.

This systematic review showed that the reasons that lead patients not to comply with fertility treatment recommendations vary accordingly to the stage they are in treatment. The most common ones across the different stages are delaying the decision to continue for more that one year (decisional avoidance), the psychological and physical burden of treatment and partnership problems. Gameiro, S., Boivin, J., Peronace, L. A., & Verhaak, C. M. (2012). Why do patients discontinue fertility treatment? A systematic review of reasons and predictors of discontinuation in fertility treatment. Human Reproduction Update, 18(6), 652-669. doi: 10.1093/humupd/dms031

Psychosocial adjustment after unsuccessful fertility treatment People undergo fertility treatment because they have a strong wish to be parents and think that they won’t be as happy if they don’t have children. But is this really true? I have been conducting research that shows that adjustment after fertility treatment is more strongly associated with women’s desire to have children than their actual parental status. These findings have multiple serious implications for care provision, for instance, should we really be encouraging patients to undergo treatment or make them reflect about other alternatives to treatment, including accepting childlessness?

Within this topic, I am currently developing a web-based intervention to support individuals who find it very difficult to come to terms with their undesired biological childlessness.

This paper showed that women’s mental health after infertility treatment is more strongly associated with their wish to have one or another biological child than with their actual parental status (i.e., if they have biological children or not). Gameiro, S., van den Belt-Dusebout, A. W., Bleiker, E., Braat, D., van Leeuwen, F. E., & Verhaak, C. M. (2014). Do children make you happier? Sustained child-wish and mental health in women 11-17 years after fertility treatment. Human Reproduction, 29(10), 2238-2246.

Transition to parenthood Becoming a parent is challenging for everyone. The period before and immediately after the birth of the child, i.e. transition to parenthood, is proven to be particularly demanding and of increased risk for poor mental-health and strained partnerships. But do all parents experience this period in the same way or is it specially challenging for particular groups of parents?

I conduct longitudinal prospective studies to understand how couples or single parents adjust during this very important life transition.

This paper showed that all parents that conceive spontaneously or with assisted reproduction get closer to their family members in order to create a social environment that is supportive and rich in opportunities for the child to establish social relationships. We named this phenomenon social nesting. Gameiro, S., Boivin, J., Canavarro, M. C., Moura-Ramos, M., & Soares, I. (2010). Social nesting: Changes in social network and support across the transition to parenthood in couples that conceived spontaneously or through Assisted Reproductive Technologies. Journal of Family Psychology, 24, 175-187.

Reproductive decision-making Since the appearance of oral contraception parenthood became a planned and complex decision that is balanced with multiple competing goals in life such as developing a professional career. Advances in assisted reproductive technologies made this decision even more complex by opening new venues to achieve parenthood. I conduct observational studies and surveys to understand

the factors that affect how people make decisions about having children

how people use new reproductive technologies, for instance fertility preservation

This paper showed that women have higher intentions to use fertility preservation when they feel susceptible to infertility, consider fertility preservation useful to achieve parenthood, perceive the implications of infertility as severe, expect to have children at a later age and have fewer ethical concerns about fertility preservation. This suggests an increase of fertility awareness is necessary for the optimal use of fertility preservation. ter Keurst, A., Boivin, J., & Gameiro, S. (in press). Women's intentions to use fertility preservation to prevent age related fertility decline. Reproductive BioMedicine Online.

Using comics as a research tool Very recently I started leading a multidisciplinary research project that brings together my research interests and one of my hobbies: graphic novels. Myself and colleagues from the fields of political science and visual communication designed a pilot project that will be the first to explore the use of comics drawing workshops as an innovative and cultural-sensitive methodology for investigating and disseminating findings about the infertility experiences of ethic minority women in Wales. The main findings will be disseminated in the form of a comics booklet (designed by a comics artist based on the visual and linguistic data) and an exhibition. Due to their visual nature, these formats are expected to be more appealing to a broader audience than scientific publications.

Extract from Al-Jawad, M. (2013). Comics are research: Graphic narratives as a new way of seeing clinical practice. Journal of Medical Humanities.

Research group

We study all aspects of fertility health to better understand the experiences of men and women trying to become parents. Our work creates the science to support people trying to become parents because it:

Helps to better document the experiences of people trying to conceive

Supports people trying to conceive

Optimises conditions for fertility

Guides professionals to take a patient-centred approach in their care of people trying to conceive

Research line “Relations, Development and Health” of the Institute of Cognitive Psychology, Vocational and Social Development of the Psychology and Educational Sciences Faculty of the University of Coimbra.

Postgraduate research interests

My research explores how different ecological contexts influence adjustment to challenging circumstances across the life cycle, such as developmental transitions and/or health conditions. My main applied field of research is Infertility and Assisted Reproductive Technologies. My research concerns are: (1) parent-child and couple relationships; (2) transition to parenthood in normative and challenging circumstances such as after assisted conception; (3) adherence to fertility treatment; (4) wellbeing and quality of life; (5) dyadic interdependence in adjustment and reproductive decision-making (e.g., how husband and wife influence each other when deciding about fertility treatment uptake).

If you are interested in further information regarding my postgraduate research, please contact me directly (contact details available on the 'Overview' page).

Prospective Students

Sara Mesquita (Joint Supervision with Jacky Boivin) - How do couples regulate to major life goal blockages? Learning from the infertility experience. Sara will investigate how couples self-regulate when facing infertility, a blockage to their parenthood life goal. She is interested in understanding individual and dyadic differences in couples’ decisions to engage in their parenthood goal by doing (more) fertility treatment or reengage in other alternative goals (e.g. professional career, the couple relationship, etc.).